Ask Adele: 10 Tips to Operationalize Patient-Centeredness

Question:My organization is working to become a patient-centered medical home (PCMH) through NCQA. This is quite a transformative process and I was wondering if you had any suggestions to help make patient-centeredness “real”? And, can it truly impact my revenue?

Answer:

The patient-centered movement is actually one that applies to the entire care continuum and is not limited to the primary care physician (PCP). Hospitals, specialists and non-physician providers – such as dentists – are all called to move to patient-centered care delivery. The health home is a model of patient-centeredness for primary care, but you are wise to seek a cultural shift that goes beyond the essentials required to achieve NCQA recognition; and, your patients will benefit directly from such thinking.

As you are aware, providers are expected to meet a growing array of quality measures that will factor into measuring value in replacing volume as the determinant of provider compensation. Likewise, patients are also expecting more from their providers in terms of access and transparency. This is driven by the intended goal of healthcare reform to foster stronger relationships between patients and physicians, encouraging patients to become more informed and responsible for their health.

As this shift from reactive care to prevention and wellness takes shape, providers have the opportunity to position their clinics to be at the forefront of healthcare reform by focusing on patient-centered operations that place an emphasis on patient engagement and satisfaction, coordinated care and relationship building. Accomplishing these goals may be easier said than done, but there are several tools available to help you receive reimbursements for the costs involved and ultimately achieve success amidst the challenging world of healthcare reform.

The following 10 tactics can help guide your practice in the right direction as you make the transition to patient-centered operations:

1.Improve transitions of care (TOC) to increase quality and decrease costs. Consult with patients on the steps they need to take toward wellness after they leave your clinic or another care setting to ensure care continuity. The AMA has created five CPT codes now being accepted by Medicare as well as other payers that relate to TOC discussions and coordinated care. Also implement these workflows to help create a patient-centered design.

·99495 – Requires a documented physician conversation with the patient/caregiver within 2 days of facility discharge about care transitions (not necessarily face-to-face) with a follow-up visit within 2 weeks;

·99456 – Has the same requirements as 99495, except the face-to-face follow-up visit must occur within 1 week;

·99487 – Billable for the first hour of staff time spent doing care coordination over a 30-day period in the absence of a face-to-face visit;

·99488 – Used to report the first hour of staff time for care coordination over a 30-day period with a face-to-face visit; and,

·99489 – Billable for subsequent 30-minute increments of staff time (directed by a physician) for care coordination beyond the initial hour billed under 99487 or 99488.

Check to see if your Medicaid agency and commercial payers also reimburse for these actions.

2.Use Health IT to track patient adherence with evidence-based guidelines for disease management and preventive services. Certified EHR Technology (CEHRT) will offer population management tools for tracking adherence, outreach and disparity reduction. Not only does this promote quality of care for the patient, getting these patients in for needed care can generate quality-based revenue for the practice.

3.Expand access to care by implementing open access scheduling and expanded office hours. Open access, or same-day appointment scheduling, can have a significant impact on no-show rates. You may also wish to expand clinic hours to improve clinical access at an appropriate level of care. For instance, patients who use an emergency department for urgent care needs will receive inconsistent care because they are seeing a different provider each time and incurring needless expense when a high-quality, low-cost option is available. This can result in tremendous waste of precious healthcare dollars. Consider offering early morning, evening and weekend appointments to your patients and make sure to communicate the available access. Nothing frustrates me more than seeing ERs advertise “less than a 30 minute wait” on billboards, which promotes inappropriate use.

4.In a similar vein, coordinate with other community providers in your area to expand access through an “on-call” provider after hours. This action can have a significant impact on patients accessing an appropriate level of care by offering extended call coverage for urgent care situations. You may also think about setting up a “nurse line” to manage after hours calls and triage patient for follow-up care, as appropriate.

5.If you have not already done so, measure physician access and staff responsiveness through your patient portal. Patient portals create a place for secured email messaging for medical questions, refill requests, Q&A and appointment requests. Secured messaging with patients is a new measure under Stage 2 Meaningful Use and can significantly cut down on unnecessary phone-tag workflows, promoting cost-efficient processes. If you are having patient adoption problems with your patient portal, brain-storm creative ways to promote a shift in patient communication behavior by advertising the portal on hold music; training staff to educate patients that they can request an appointment or refill through the portal when they call; strategically placing placards around the clinic; holding a drawing for a free dinner for patients who sign-up for the patient portal.

6.Consider offering eVisits. An electronic visit or eVisit is a web-based encounter for non-urgent clinical questions through secured patient portal messaging. Virtual visits allow easy access to a provider anywhere at any time. Check to see what you need to document in your CEHRT to receive reimbursements for eVisit charges since there is a heightening awareness of the cost savings achievable with many payers.

7.Distribute patient satisfaction surveys with questions related to facilities, comfort, patient flow, etc., to identify internal issues as well as positive testimonials. Patients will appreciate your efforts, so make sure to answer all response questions and concerns in a timely manner. Surveys can also establish a formal method for patient feedback and identify unknown areas of problems. Research supports a link between strong provider-patient communication and patient satisfaction, guideline adherence and improved outcomes, making this feedback critical to understanding the call to action given your patients and their preferences. Patient experience measures are growing as a metric of value in new alternative reimbursement models under health care reform. So, improving metrics linked to patient experience can also impact clinic revenue in the long-term.

8.Conduct annual staff training focusing on sensitivity to patient needs, cultural differences and customer service. Assess your staff’s ability to determine patient comprehension of treatment goals through such techniques as “teach-back.” Educate your team on shared decision-making with the patient, exploring all treatment options and incorporating the patient’s point-of-view into agreed care plans. This will not only assist with treatment adherence and outcomes, but will bolster ratings linked to patient experience. And, smile. Research supports that a single smile can deliver as much brain stimulation as 2,000 chocolate bars![1]

9.Openly display policies and procedures related to patient access and communication. Posting signs in waiting rooms and exams rooms or distributing policy information in new patient packets builds trust and credibility. Transparency will also decrease issues linked to a breakdown in communication.

10.Conduct regular training on your Health IT, especially when new technological enhancements are released. You should always improve your use of technology so that it is serving the practice to better serve the patient. As the country undergoes a shift to automating clinic workflows under reform, keeping abreast of software improvements will reduce the burden of manual, laborious processes. Utilize the support, maintenance and upgrades your EHR vendor provides to ensure your staff is taking full advantage of the technology’s capabilities in order to enhance patient care.

Congratulations on your move toward formal recognition! I hope these tips serve to make patient-centeredness as “real” as it can get.

Do you have a question? Let us know! Contact membership@nwrpca.org to submit your questions to “Ask Adele.”

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This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U58CS06846, "S/RPCAs," total award $950K, with 65 percent of program funded by nongovernmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.